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PEAMITTEE NAMEJADDRESS nno&*FworpNr.a/Lor.n.n ?OfO?n+1 <br />NAME . <br />ADDRESS <br />uuA 144Jtj <br />SAE) l.Ca Ai` <br />FACILITY jIDL Nuhrfl G SCJ'l ` I liWi- <br />LOCATION P A L I :i A O E cC, LI I <br />I,N I _ ulrr:Li v <br />NATIONAL POLLUTANT DISCHAAOE ELIMINATION SYSTEM /WDESI <br />DISCHARGE MONITORIN43 REPORT (DMR) <br />PERMIT NUMBER DISCHARGE NUMBER <br />MONITORING PERIOD <br />FROM YEAR MO DAY TO YEAR MO DAY <br />Form Approved <br />OMB No 2040-0004 <br />6n? <br />F - F1hPL <br />f::nD IC; IC COAL Chtte <br /> <br />PARAMETER QUANTITY OR LOADING QUALITY OR CONCENTRATION NO. FREQUENCY SAMPLE <br /> <br /> AVERAGE MAXIMUM UNITS MINIMUM AVERAGE MAXIMUM UNITS EX ANALYSIS TYPE <br /> SAMPLE <br />M <br />S <br /> EA <br />UREMENT <br /> PERMIT 5 ' <br /> REQUIREMENT ? 1 .v Y t t <br /> <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT . r!- Lai .:•: e F C ' "_ .: i_ <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT r rtiri i? ?1tTID oIAL <br /> REQUIREMENT <br /> <br />L I J L ?' <br />L Nl <br /> SAMPLE <br /> MEASUREMENT <br /> <br /> P <br />I <br /> ERM <br />T Lkl.n. "EI"G'r.` ?rIY. a : <br /> REQUIREMENT <br />A !. <br />t <br /> SAMPLE <br /> MEASUREMENT <br /> R <br />y PE <br />MIT E E C P I L Y i A <br /> REQUIREMENT <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> L ? :. 1 v 4 = :,. > .,. <br /> REQUIREMENT 1 h? 7 i' it $ <br /> SAMPLE <br /> MEASUREMENT <br /> PERMIT <br /> <br /> REQUIREMENT <br /> <br />NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I anlq ° u Penalty 0 low that Ihh, doevmenl and atl ¦uachment, were <br />re <br />ared u <br />de <br />i <br />I TELEPHON <br /> <br />p <br />p <br />n <br />r my d <br />rer6on oe mpt. <br />on in accord nre <br />a with a system designed <br />In a <br />th <br />t <br />lin E DATE <br />- dore <br />a <br />qua <br />ed personnel properly Sather and eya1_1. the Infnemalk n <br /> submitted. Bred en my Inquiry of the Person or persona who manage the system, <br /> or those persorei directly mporMble for gathering the Infors lion, The Inform.tion <br />submllled K t <br />th <br />be <br />t (m <br />k <br />l - <br /> o <br />e <br />l <br />y <br />now <br />edge and belief. Imc attvnle. and complete. <br />1 am swan that them ¦m sltnlncant penalHas fo <br />ubmitti <br />r <br />t <br />I <br />f <br />I - <br /> r s <br />ng <br />a <br />n <br />e <br />ormation, S <br />GNATURE OF PRINCNAL EXECUTIVE <br />TYPED OR PRINTED <br />nnuucutC a_aln CYDI .u.Tlnu tic •luV Vint Includint the Possibility of tine and Imprisonment for knowing Ndauom <br />ATlnklc m_i______ _w OFFICER OR AUTHORIZED AGENT A A NUMBER <br />CODE YEAR MO DAY <br />....?.?:. EUitt`ss?L1.Lh\A".', tf+ptq <br />HR Li%cC.lb. LVEL41 CIC <br />EPA Form 3320-1 (Rev. 3199) Previous editions may be used. This is a d-pall COrm. PAGE OF